Please see my article below and if you are choosing not to purchase private health insurance, you can join me in sending a message to President Obama by sending him an email with this petition.

[emailpetition id=”7″]

Why I Am A Conscientious Objector To The ACA

I have been an outspoken advocate for a Medicare for all health system. During the health reform process, I did all that I could to push for single payer, including being arrested three times for civil disobedience. I was one of fifty doctors who filed a brief in the Supreme Court which expressed opposition to forcing people to buy private health insurance, a defective product. It pains me to see that the Affordable Care Act (ACA) siphons billions of public dollars to create more bureaucracy and transfers hundreds of billions of public dollars directly to the private insurance industry when I know that those dollars should be paying for the health care that so many in our country desperately need.

I am currently uninsured, so I have to make a choice. I don’t qualify for Medicaid and I’m too young for Medicare. By law, I am required to buy private insurance or pay a penalty. But I find myself in the position of not being able to do either. I can’t in good conscience give money to the health insurance industry that I am fighting to eliminate. And I can’t in good conscience pay a tax penalty that will be given to that industry. So, I am going to be a Conscientious Objector to the ACA.

I suspect that there are others who feel as I do. If you are planning to object to purchasing insurance and you support Medicare for all, you might like to join me in sending a letter to President Obama. See the petition above.

The Issue is Access to Care, Not the Number Who Buy Insurance

As the March 31 deadline to purchase health insurance or face a penalty approaches, the public debate is focused solely on enrollment numbers. Great efforts are being expended to compel people to buy insurance. The “Young Invincibles,” a term created to misrepresent uninsured young adults, are being marketed heavily. And Enroll America, a coalition of advocates and health industry executives, is working overtime to encourage volunteers to be creative in the ways they locate and convince people to purchase insurance.

The mass media and politicians are constantly talking about the health care marketplace. We are being indoctrinated with market rhetoric. Patients are called consumers and health insurance plans are called products. The problem with this is that health care doesn’t belong in the marketplace whose logic dictates that care should be denied if a profit cannot be made. Health care is a public good and something that everyone needs throughout their lifetime.

Focusing solely on the number of people who are insured is what the private health insurance industry wants the public to believe is most important. The industry spent tremendous amounts of money and time to get a law that would force people to buy insurance in order to protect and enhance their assets. They want everyone to buy their products and to make people feel reckless or irresponsible if they don’t. This is a massive campaign to distract people from asking the questions that really matter, such as whether people with insurance will be able to afford health care, whether bankruptcies from medical debt will continue and whether overall health outcomes will improve.

In the United States, having health insurance does not guarantee access to necessary health care. In fact, rather than creating health security, the ACA is degrading health care coverage in the US. It is also creating the largest transfer of public dollars to a private industry ever, as UNITE HERE reports “most of the ACA’s $965 billion in subsidies will go directly to commercial insurance companies.”

The Insurance Scam

As Kevin Zeese and I wrote last fall, the ACA is one of the biggest insurance scams in history. It has made the already complex American health system, which spends over a third of health care dollars on insurance-created bureaucracy rather than care, much more complicated. It is based on principles that are the opposite of what are proven to be effective. Instead of being universal, everybody automatically enrolled as we did for seniors when Medicare started in 1965 and as most other industrialized nations do, we created a conservative, means-tested system that depends on individual income.

And instead of creating a single standard of care, so that everyone has access to the health care they need, the ACA locked into law a tiered system of coverage based on different metals: platinum, gold, silver and bronze. Though they may sound good, it turns out that the upper tier plans are not any better than the lower tier plans in terms of what services are covered or where patients can go for care. The major difference is whether a person chooses to pay more up front in higher premiums and pay less when they need health care (upper tier plans) or chooses to gamble on staying healthy and pay less up front, risking higher out-of-pocket costs if they need care (lower tier plans). This is essentially a pay-now-or-pay-later scheme.

And it is a scheme, because there are no guarantees that people who have insurance will be protected from financial ruin if they have a serious health problem. It is essential to remember that nothing about the basic business model of insurance companies has changed. They exist to make a profit and they are very good at it. While they complain about the ACA, because its regulations require more work on their end to find ways around them, it has been very lucrative for them. Health insurance stock values have doubled since the law passed in 2010.

One of their major work-arounds is the use of narrow and ultra-narrow provider networks to discourage patients with pre-existing conditions from buying their plans and leave patients footing more of the bill. Narrow networks exclude at least 30% of local hospitals and ultra-narrow networks exclude at least 70%. This means that if the local cancer center isn’t included in a plan, then people with cancer are unlikely to buy that plan. To make it worse, it’s difficult for patients to determine what providers are included in different plans because the information on the insurance exchange websites has been found to be wrong half the time.

The reason for the narrow networks is that when patients don’t go to an approved health provider, they bear most or all of the costs. The limit on how much money people can be required to spend in addition to premiums doesn’t apply when patients go out of network (and the limit was removed for 2014 anyway). In practice, if someone develops a serious health condition and the hospital or health professional that treats the condition is not in their network, they will have to go without care or find a way to pay for it. And if a person has a serious accident and is taken to a hospital that is out of network, the patient will again bear the total cost. Buying insurance is a health care crap shoot.

The Race to the Bottom in Health Care Benefits

Medical bankruptcy and self-rationing, foregoing necessary care due to cost, are two products of our market-based health system and we can expect them to continue under the ACA, even as more people become insured. Supporters of the ACA often quote the slowed rise of health care spending that has been happening since the financial crash in 2008. They claim it is a sign of the law’s positive effect; however, the slowing is actually due to fewer people using health services. In 2012, 80 million people went without necessary care because of cost.

Self-rationing will continue because there has not been an economic recovery for most of us. More than 80% of people are buying lower tier health plans that require high up-front payments for care at a time when most families are living paycheck to paycheck. The number of people who are considered poor or low income is rising. And, as Paul Bucheit writes, if we updated our standards for measuring poverty to reflect the current economic realities (the costs of food, housing, health care, education, etc), the poverty threshold would be over three times higher than it is now. He adds that half of the US population owns zero wealth because of debt. It is a sad irony that people are being forced to pay monthly premiums for health insurance that will leave them without money for actual care.

And now that lower coverage plans are legal, they are accelerating the race to the bottom in employer health benefits. Employers are shifting more of the cost of health care onto employees, reducing coverage for dependents, moving employees into private insurance exchanges (which do not qualify for subsidies) and penalizing employees for poor health habits, which places the blame for health problems on the individual without acknowledging that many drivers of poor health are out of the individual’s control. While tying health care to employment is not ideal, in the US at least the employer-based plans used to provide better benefits than those on the individual market.

The Practical Solution

The solution to the ongoing health care crisis is obvious. We need to reverse direction completely and move to a national publicly-funded health insurance for everyone. Some call this a single payer or ‘Medicare for all’ plan. We are already spending enough on health care in the US to provide high quality care to everyone. It is just wrong from a standpoint of what works to continue shifting more of our health care dollars to bureaucracy instead of to care and to the private insurance industry which is designed to keep as much for itself as it can get away with. It is immoral to protect insurance company profits instead of protecting the health and well-being of our people.

Putting our money into the insurance industry is a step in the wrong direction. The Expanded and Improved Medicare for All Act, HR 676, in Congress, would eliminate the insurance industry and create lifelong comprehensive coverage for everyone. No matter what you choose to do about insurance, tell your Congress member to support HR 676. And if you are one of the millions who do not plan to buy insurance, join me in telling Obama why. See the petition above.

MSNBC host Lawrence O’Donnell is not one of them. Ever since the law passed, he has told his viewers to not fear the individual mandate. He said it again on The Last Word with Lawrence O’Donnell on Oct. 21, 2013 while scolding a White House correspondent.

“No one ever really has to pay the fine in the individual mandate,” O’Donnell said, “because the IRS has been specifically forbidden, in writing, in law, in the Affordable Care Act, from ever actually pursuing either civil or criminal remedies to collect those fines from anyone. The individual mandate is the only provision in the tax code that was written deliberately to be essentially unenforceable.”

Good idea to offer tweet…bad idea to make tweet more than 140 characters!

Gayle Bourne

With a $5000 deductible I would never receive any actual healthcare. I don’t have that kind of money laying around every year. A recent poll revealed most people do not undertstand about deductibles. They are in for a nasty surprise. I am not going to give money to a for- profit corporation that is already making billions-with-a-B in profit by denying people healthcare and medicine that they need. It is a scam, and I refuse to pay money for nothing.

The ACA is representative of everything that is wrong with America. Profit over people. Ballooning inefficient bureaucracy which will lead to the collapse of the country. The dismantling of the social safety net. Government corruption where the Obama administration publicly advocated for single-payer healthcare while privately reassuring the private healthcare industry that there would be no single-payer option.

Medicare for all and a guaranteed national income would be all the social safety net the US would ever need as long as we had a government that tries to include people for government services instead of trying to exclude them.

Margaret Flowers – you deserve better.

1prairie_dog2

I am an elder on Medicare. I cannot see a doctor because I cannot afford the co-pay. Universal Health is the only way to go and it must include dental as well. Medicare does not and dental problems are a major factor for the elderly. We don’t need insurance companies raking in millions from the working class. We need Universal Health. It is a shame that the US is one of the poorer providers of health care for its citizens. We have plenty of money to kill people but none to help them. This is not freedom.

sweetroxie

I am a senior, so I have Medicare. I have been staying out of the fray of the ACA even though it was clear to me that the program sucks–is overly bureaucratic and rewards the plutocrats in the heath insurance industry. Since I am not eligible for it I haven’t paid close attention to the details. The devil is in the details– as usual. Thank you, Dr. Flowers, for spelling out the intricacies of the scam. To me, as a support and consumer more of the alternative medical paradigm than of the western medical orthodoxy, I have always viewed any national health insurance as an institutionalization of a medical paradigm that is quite limited and narrow minded. While we’re pushing for Medicare for All, we should also enlarge our purview of what constitutes good healing. And that includes a lot of health-related disciplines that are more about preserving health and prevention than about the compartmentalized magic bullet approach so characteristic of the western medical paradigm.

susan edgett

I too am a conscientious objector. I will not purchase a defective product that I am morally opposed to. I wish all those without health insurance could join forces as conscientious objectors boycotting the ACA. Together we could muster some economic clout and develop some networks for care that function outside the system. Thanks for speaking truth to power.

reader121

The deductibles are ridiculous, and people who make higher temporary wages per hour (where they must save for layoff) are being gouged. Those with lower wages are basically paying twice- their premiums and then the ‘subsidy’ going to profit the corporations through their taxes.

Government healthcare was a great idea- real Single Payer like all other developed countries have.
But this is forced insurance welfare which was designed not to give care to Americans but to line the pockets of big insurance, with only some weak price controls while they enjoy having forced paying customers.

We will always be a sick nation as long as we continue to not only profit
off of our elderly, infirmed and those suffering from ill health…. but
strive to maximize “investment returns” on their misfortunes at their
expense. Whats good enough for Canadians, UK, France, Germany, Australia, Sweden, China, Iraq and all the rest is good enough for Americans. Medicare for all Now!

Margaret Flowers

Thank you Grandma. I do understand deductibles.

As I wrote:
1. The caps on out of pocket costs were eliminated this year and if they can get away with it the insurers will make sure they are gone next year too.
2. The plans are designed to push people out of network where they pay most or all of the cost (exclude major medical centers where most people go for costly care and restrict providers). In an emergency, it is a crap shoot whether you will go to a hospital in your network.
3. I would rather save the money I would pay on premiums so I can pay for care when I need it.
4. You seem to be concerned with people not paying for care. Are you also concerned about the hundreds of billions of public dollars being given to private insurance companies? That is a greater amount of welfare.

reader121

BTW, what is this ‘sort by the best’, and who is filtering the comments even here?
Whatever happened to plain ordinary most recent first.
So tired of having some people’s views selectively shown over others, everywhere on the Internet!
🙁

tomas rader

My wife was a nurse and she died practicing and sharing these views, insurance is a wager. My religion is in enough trouble but suffice it to say that it considers gambling a sin. To cooperate with insurance companies in anything is the equivalent of having a bookie in vegas and cooperating in offending God. These are valid grounds for resistance. … the religious exemption. Even the fine will be forked over to the bookie industry. As for single payer under medicare .. no way in hell. I’m a VA patient so you should also advocate substandard treatment by nurse practitioners at doctors charges. The great thing about the USA is that you have the ability to thrive if you strive. But you also have the right to be total loser … just not at public expense. Take that away and you’re in the EU system. If you like the EU system …move there.

tomas rader

So the $7000 in annual premiums is just gone if you get sick or not. Lets add that 7K to a $5000 deductible. Now we have $12000 out of pocket before the insurance company has to pay 70% of your next office visit? Sounds like catastrophic insurance before the ACA became law. What’s not to understand. Go to med school so you can be middle class at best? If you want to do humanitarian healthcare join WHO or drs w/o borders and go to Africa.

George Shaver

The best position to take in this controversy is the same whether you are democrat or republican, conservative or liberal, rich or poor. This is about health care, not politics, isn’t it?

It would be nice if they just told us the truth, that this Obama Care or ACA will be one of their tools to break our financial backs and then send us off to prison. It is not about health care benefits and it’s not about helping you afford health care.

In the end, they are going to take down everyone but the top half of the one percent and then merge America with Mexico and Canada as one country. This is not theory, it is documented, proven and in the works with the actual construction happening now as solid as concrete.

If you are poor and expecting better things as they promised you from Obama Care, you will be demonize and to be the scapegoat. The Nazi’s did this identical thing to the jews and it normalized this slaughter.

As the middle class goes through wholesale bankruptcy, the poor will be villonized and made to be the cause of the skyrocketing health care costs. People who have to pay will soon be lynching the poor in an effort to remain solvent, and God Bless the dead beat premium payor who is the new creation of Obama Care.

Gayle Bourne

Free care? Since when is having your wages garnished “free?” Insurance does not prevent people from being forced into bankruptcy. The vast majority of people who end up losing everything had health insurance and the ACA changes none of that. And you are confusing health insurance with healthcare. People die every day because their ins co denies their care and/or medications. Right now I cannot receive medical care due to inability to pay. How is giving some for profit scam hundreds of dollars a month I don’t have going to change that? Just because some computer says I ought to be able to pay premiums does not mean we can afford it. We are already paying $800 a month for my husband’s ins through his job – an org which is “self-insured” and all employees are required to participate. We cannot afford any more, period. We are already paying more than our mortgage for healthCARE every month between his premiums, deductibles and co-pays. And I get no benefit from that whatsoever. He barely does. It is a scam.

Americans don’t want Medicare for all. They do want to keep the very poor separate, as we see by our social/economic policies. When medical care is allowed for the poor, we must keep it limited. The reason: We’ve embraced social agenda that has profoundly impacted the poor. Since welfare “reform,” the overall life expectancy of America’s poor has fallen by 5-6 years; in a nation that has shipped out a massive portion of our working class jobs, and then wiped out poverty relief, conditions will steadily deteriorate. It doesn’t make much sense to “patch up” the poor just to send them back out on the streets where they are denied adequate food and shelter. Right?

DHFabian

Fair? It’s fair, then, to require people to pay what they can’t afford? Times have changed. We have a significant shortage of working class jobs, and wages have fallen well behind the cost of living. Our better-off can’t seem to grasp that this means that after covering the most basic needs, there is simply no money left.

DHFabian

This is true. But at the heart of the discussion is that today’s generation does believe that if you can’t afford it, you don’t deserve it. I believe our social policies stand as proof that we would rather have people die than allow any sort of aid.

DHFabian

We need to start using the people’s money for the benefit of the people and the nation — not just to cover the costs of moving our jobs out of the country. As an American, I do NOT want any person in this wealthy nation to go without basic human needs, food and shelter, simply because of the whims of the job market. Not everyone can work, due to health or circumstances, and we don’t have jobs for all who need one. We’ve shipped out a huge portion of our working class jobs since the 1980s. What is more anti-American than turning our backs on those who have been pushed out of our shrinking job market?

DHFabian

I have my doubts because this generation did embrace the “You’re On Your Own” philosophy and agenda, as we see with our social policies.

There are two ways we can go. One would be to demand some things like healthcare, food, shelter and education as rights. The other would be to change the system: publicly funded elections, proportional representation, instant runoff voting, eliminating the electoral college, etc. Our masters are more likely to give on the former as to not upset the system as it stands now (and how it was designed to function, I might add). But whatever we decide to do, let’s get to work on it. There’s no time to lose.

kevinzeese

Those are not inconsistent or mutually exclusive strategies, in fact they are synergistic. People are already pursuing both and we encourage both tracks.

Human rights needs to be something much better understood in the US. We have human rights guaranteed by international treaties to which the US has signed, but they are denied here. People need to know they have these rights and take them.

The US proclaims itself the greatest democracy of all time, in fact it is a mirage democracy with managed elections where the rule of money has replace the rule of the people.

These are both foundational issues that need to be pursued.

Malia Seals

Thank you, Margaret Flowers, for your unwavering, rational defense of single-payer health care in the US. Private insurance is a scam and the worst thing about the ACA is that the insurance mandate warps public perception to accept private insurance as a legitimate path to care. Those of us staying in the fight for universal care must now recover the minds of those who fell for the ACA–hook, line and sinker.

To listen to the media, you’d think the only issue was how many people will sign up…how many people will get insurance (not necessarily the same thing, since we still don’t know for certain how many ACA signups were previously uninsured). Now the ACA supporters are crowing about their ‘impressive’ enrollment numbers, as if the mere fact of more people having some kind of insurance makes everything okay. What they still fail to grasp is that health insurance does not equal health care, and many millions will continue to be left behind by our dysfunctional, cripplingly expensive system. The ACA is nothing but a wolf in sheep’s clothing, and in the end, it won’t solve the real problems. For the sake of the country, we need to keep up the fight to replace it with single payer.

Pooka Ness

AHC wasn’t perfect. I wanted single payer too, but I joined it and it improved my financial situation immensely. My husband and I had been paying almost $10,000 a year, for a $5000 deductible insurance policy. That was more than half our income. With AHC we now pay less then $100.a month for a slightly better policy. MONEY write policies, and until we do something about that, nothing will change. So I picked the best I could.

Now people are getting it at last. We need to invent a PEOPLE’S single payer system that bypasses BOTH this onerous federal program and the cretins who stand in the way of a single payer system, AND the avaricious insurance companies! Blindside them both! If enough people can come together an d organize, we hire our OWN medical personnel, clerical staff, accountants and attorneys, etc. ALL at a fair and reasonable salary. Their job is to take care of patients using the best science, including alternative therapies, available. All in favor, say “AYE!”

reader121, no one here is filtering comments. Except Disqus, if you consider that “filtering.” You get to choose how the comments are displayed, whether by Oldest, Newest, or Best (Best as determined by number of Upvotes). That’s how it works with Disqus at all websites everywhere. Click the link at the top of the discussion thread to display them however you want.

Today’s generation doesn’t believe this…this is just the excuse being put out there by those who stand to benefit from the ACA (in other words, the 1%)

Anthony Noel

Obama already knows it’s a scam. It’s where the money Big Insurance gives the Dems (and GOP) comes from. We need to stop telling the corporate parties anything other than “We’re coming for you. Time to tune up your resumes.”

I am one of those people that have found myself defending and vilifying aca at the same time. I appreciate many of the safeguards the aca brought. Yet, I am also in a state that would not expand their medicaid program. My husbands employer offers insurance, but the prices are much higher than we have ever paid for a an employee/family plan before. We can put most of our kids under a chip plan, but that does nothing for myself and the two kids we have in college. So we can’t afford the employer plan, and the other private options come with such high deductibles, it made no sense. Why/how would we possibly pay $400 to $500 each month, only to still have a $5000 deductible? We would never see enough medical attention to justify the monthly payment. And if someone in my family were to need expensive emergency care, we couldn’t cover the deductible anyway. Just nonsense.

Maybe with the age of the internet, people will grow smarter about their health. They might realize that healthcare is not really needed more than marginally for accidents. People can save money by not needing health insurance, and we can end Medicare to save the taxpayer from more debt.

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